577 nm微脉冲激光联合抗VEGF药物治疗黄斑水肿的Meta分析  

Combination of 577 nm micropulse laser and anti-VEGF drugs in the treatment of macular edema:a Meta-analysis

作　　者：吴晓玉 钟福炉[1] 李成茂 郑彦 李维娜[1] WU Xiaoyu;ZHONG Fulu;LI Chengmao;ZHENG Yan;LI Weina(The 910t h Hospital of Chinese People’s Liberation Army,Quanzhou 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第九一〇医院,泉州362000

出　　处：《中国中医眼科杂志》2022年第3期247-252,共6页China Journal of Chinese Ophthalmology

基　　金：福建省泉州市医疗卫生领域指导性科技计划项目(2021N169S)。

摘　　要：目的评价577 nm微脉冲激光联合玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗黄斑水肿的临床疗效。方法检索国内外数据库,包括中国知网、万方数据库、重庆维普数据库、PubMed、The Cochrane Library、EMBASE自建库至2020年4月,收集干预组为577 nm微脉冲激光和玻璃体腔注射抗VEGF药物的联合治疗,对照组为单一微脉冲激光或者单一玻璃体腔注射抗VEGF药物治疗黄斑水肿的研究,对研究文献进行质量评价,数据提取,运用Stata 14.0和Review Manager 5.3软件对数据进行统计分析,根据Q值检验结果采用不同的效应模型合并效应量并进行敏感性分析和发表偏倚的检测。结果(1)最佳矫正视力(BCVA):联合治疗较单一微脉冲激光治疗后1、3、6个月明显提高,加权均数差WMD(95%CI)分别为-0.13(-0.15,-0.10),-0.12(-0.16,-0.08),-0.10(-0.18,-0.02),差异具有统计学意义(均P<0.05)。(2)黄斑中央厚度(CMT):联合治疗较单一微脉冲激光治疗后1、3、6、12个月明显降低,WMD(95%CI)分别为-66.90(-91.30,-42.50)μm,-75.78(-107.38,-44.19)μm,-93.01(-162.12,-23.91)μm,-23.81(-46.24,-1.38)μm,差异具有统计学意义(均P<0.05);联合治疗与单一注药组治疗后3个月CMT对比WMD(95%CI)为20.45(2.45,38.44)μm,差异具有统计学意义(P<0.05)。(3)抗VEGF注药次数:联合治疗组较单一注药组,玻璃体腔注射药物针数减少,合并效应量WMD(95%CI)为-1.52(-2.63,-0.40)针,差异具有统计学意义(P<0.05)。结论577 nm微脉冲激光联合玻璃体腔抗VEGF药物较单一微脉冲激光在治疗黄斑水肿的早期效果显著,可明显提高BCVA(<3个月),减轻水肿程度(≤6个月);与单一玻璃体腔注射抗VEGF药物相比,能有效减少抗VEGF药物的注射次数。OBJECTIVE To systematically evaluate the clinical efficacy of 577 nm micropulse laser combined with intravitreal injection of anti-VEGF drugs in the treatment of macular edema.METHODS Studies involving treatment of macular edema with observation group treated by 577 nm micropulse laser combined with intravitreal injection of anti-VEGF drugs and control group treated by single micropulse laser or single intravitreal injection of anti-VEGF drugs were retrieve from database as CNKI,Wanfang database,Chongqing VIP database,PubMed,The Cochrane Library,EMBASE update to April,2020.We evaluated the quality of included studies,extracted data like best corrected visual acuity(BCVA)which was expressed by logMAR,central macular thickness(CMT)and the number of injections.Stata 14.0 and Review Manager 5.3 software were used for statistical analysis of the data.Different effect models were used to combine the effect sizes according to the Q test results,and sensitivity analysis and publication bias detection were conducted.RESULTS(1)BCVA:Compared with the micropulse laser treatment,the combined treatment significantly improved BCVA at 1,3 and 6 months after intervention,and the weighted mean difference WMD(95%CI)was as follows-0.13(-0.15,-0.10),-0.12(-0.16,-0.08),-0.10(-0.18,-0.02),the differences were statistically significant(all P<0.05).(2)CMT:Result of combined treatment group was significantly lower than that of micropulse laser treatment at 1,3,6 and 12 months after intervention,WMD(95%CI)were-66.90(-91.30,-42.50)μm,-75.78(-107.38,-44.19)μm,-93.01(-162.12,-23.91)μm,-23.81(-46.24,-1.38)μm,the differences were statistically significant(all P<0.05).Compared with injection group,CMT of the combined treatment group WMD(95%CI)was 20.45(2.45,38.44)μm 3 months after treatment,the difference was statistically significant(P<0.05).(3)The reduced injection dosages of combined treatment WMD(95%CI)was-1.52(-2.63,-0.40)doses,the difference was statistically significant(P<0.05).CONCLUSIONS The combination of 577 nm micropulse laser a

关 键 词：黄斑水肿 577 nm微脉冲激光 抗VEGF药物 META分析 

分 类 号：R774.5[医药卫生—眼科]